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- Association for Assisted Living Nurses Formed
- Increase Daily Activity for a Longer Life
- Five Combined Healthy Habits Equal Lower Heart Disease Risk
- Screening Colonoscopy in Very Elderly Patients
- Life Expectancy of Elderly and Very Elderly Patients with Chronic Heart Failure
- Labor of Love: Free Online Nursing Journal Celebrates 10 Years
Association for Assisted Living Nurses Formed
A new organization, the National Assisted Living Nurses Association (NALNA), has recently been formed and will be headed by Dee McGinnis, RN. NALNA is the first educational organization formed specifically to provide support and advocacy for nursing professionals in the assisted living setting. NALNA is the culmination of nearly 2 years of research and development by the National Association of Directors of Nursing Administration/Long Term Care (NADONA/LTC). The core mission of the new organization is the continuation of NALNA members’ clinical education. NALNA will exist under the organizational and administrative umbrella of NADONA. The new group will also publish a journal, “The Nurse in Assisted Living,” which will contain clinical information as well as items and sections specific to assisted living and its challenges.
Source: National Association of Directors of Nursing Administration/Long Term Care press release, May 16, 2006.
Increase Daily Activity for a Longer Life
Although an association among physical activity, better health, and longer life has been found, a direct link between activity and longevity for older adults has been limited, according to researchers who used a unique protocol to measure the effect.
The 302 men and women (aged 70–82 years) who participated in this study were community dwelling and high-functioning in that they reported the ability to walk 0.4 m or climb at least 10 stairs. Their total energy expenditure was measured for 2 weeks using a “doubly labeled water” method. Participants drank the water and provided urine samples, which allowed researchers to calculate carbon dioxide production and total energy expenditure. Daily activities were recorded during in-person interviews.
The group was divided into 3 categories: high, middle, and low levels of activity energy expenditure. Over an average of 6.15 years (1998–2006), 55 participants (18.2%) died. The absolute risk of death was 12.1% in the highest third of activity energy expenditure, 17.6 % in the middle, and 24.7% in the lowest third.
People reporting higher levels of activity were more likely to work for pay and climb stairs. However, there was no significant difference between the high, middle, and low activity groups for high-intensity exercise, such as walking for exercise, walking other than exercise, volunteering, and caregiving. The authors suggested that this lack of relationship is because of the inaccuracies of self-reported activity levels.
The message, commented lead author Todd M. Manini, PhD, is that any activity is better than no activity. The authors stated that “simply expending energy through any activity may influence survival in older adults.”
Source: JAMA 2006;296:171
Five Combined Healthy Habits Equal Lower Heart Disease Risk
Middle-aged and older men who practiced 5 healthy lifestyle behaviors during a 16-year period had a significantly lower risk of developing heart disease than men who had fewer healthy habits. Even those receiving treatment for high blood pressure or high cholesterol experienced a reduced risk.
“Many healthy lifestyle factors are associated with a lower risk of coronary heart disease,” said Stephanie Chiuve, ScD, lead author of the study and a research fellow in the Department of Nutrition at the Harvard School of Public Health in Boston, Mass. “We looked at the health impact when all 5 healthy lifestyle factors were considered in combination.”
Researchers examined these 5 factors of a heart-healthy lifestyle:
Chiuve and colleagues studied 42,847 men, aged 40 to 75, who were free from chronic diseases such as heart disease, diabetes, and cancer at the start of the study. The participants provided information on their medical condition and lifestyle factors every 2 years, starting in 1986, through self-administered questionnaires. Twenty-one percent of the men took medications for high blood pressure or high cholesterol.
“One of the strengths of this study is that every 2 years we collected detailed updated information on lifestyle factors such as BMI or smoking status and also medical confirmation of newly diagnosed heart disease,” Chiuve said.
They found that 2,183 of the men had a heart attack or developed fatal coronary heart disease) during the study. Men who had all 5 healthy factors had an 87% lower risk for coronary heart disease, compared with men who had none of the healthy lifestyle factors. Researchers found that 62% of coronary events could have been prevented if all men in the study population adhered to the 5 healthy lifestyle factors.
What had not been studied before was the parallel benefit of healthy lifestyle factors among men already with higher risk health conditions. Among men taking medications for high blood pressure or high cholesterol, 57% of all coronary events may have been prevented with a healthy lifestyle, she said. Those who adopted 2 or more healthy characteristics had a 27% lower risk of coronary heart disease compared with those who did not.
“We found that a healthy lifestyle, defined by these 5 factors, is associated with lower risk of coronary heart disease, even when men are taking medication to lower their blood pressure or cholesterol,” Chiuve said. “And while we want to encourage a healthy lifestyle throughout people’s lives, this study shows that it’s never too late to make changes to become healthier. You can still achieve significant benefit by making changes in middle age or later in life.”
Source: American Heart Association rapid access journal report. Available: www.heart.org/presenter.jhtml?identifier=3040595.
Screening Colonoscopy in Very Elderly Patients
Current guidelines do not include an upper age cutoff for colorectal cancer screening with colonoscopy. Although the prevalence of colonic neoplasia increases with age, life expectancy decreases. Thus, the benefit of screening colonoscopy in very elderly patients may be limited.
A cross-sectional study compared estimated life-years saved with screening colonoscopy in very elderly versus younger persons. The study conducted was among 1244 asymptomatic individuals in 3 age groups (50–54 years [n = 1034], 75–79 years [n = 147], and ≥80 years [n = 63]) who underwent screening colonoscopy at a U.S. teaching hospital and clinic.
The study included prevalence of various types of colon neoplasia; estimated gain in life expectancy, calculated as life expectancy – (life expectancy during polyp lag time + life expectancy after colorectal cancer diagnosis); and comparison of mean gain in life expectancy across the 3 groups. Life expectancy and mortality data were derived from life tables, previous studies, and national databases.
The results showed the prevalence of neoplasia was 13.8% in the 50- to 54-year-old group, 26.5% in the 75- to 79-year-old group, and 28.6% in the group aged 80 years or older. Despite higher prevalence of neoplasia in elderly patients, mean extension in life expectancy was much lower in the group aged 80 years or older than in the 50- to 54-year-old group (0.13 vs. 0.85 years). In sensitivity analysis, with longer polyp lag times the mean extension in life expectancy decreased more in the elderly than in the younger patients; alternatively, if it was assumed that a smaller proportion of adenomas progress to colorectal cancer, the mean extension in life expectancy decreased less in the elderly than in the younger patients.
In conclusion, even though prevalence of neoplasia increases with age, screening colonoscopy in very elderly persons (aged >80 years) results in only 15% of the expected gain in life expectancy in younger patients. Screening colonoscopy in very elderly patients should be performed only after careful consideration of potential benefits, risks, and patient preferences.
Source: JAMA 2006;295:2357-65.
Life Expectancy of Elderly and Very Elderly Patients with Chronic Heart Failure
The survival of patients with chronic heart failure is typically reported as a comparison of different groups of patients using the hazard ratio from a Cox proportional hazards analysis. The absolute survival is generally neglected. Furthermore, attention is often focused on relatively young patients, although chronic heart failure largely affects older patients. This study was undertaken to determine the life expectancy (a measure of absolute survival) of older patients with chronic heart failure.
Patients aged over 75 years with chronic heart failure caused by impaired left ventricular systolic function who attended an outpatient clinic were included in the study. Follow-up commenced on August 1, 1993, and continued until September 30, 2005, when vital status was ascertained. Mean survival time was calculated as a measure of life expectancy.
There were 210 patients included in the study. Male patients of mean age 80 years had a life expectancy of 3.9 years (95% confidence interval [CI] 3.2–4.5), compared with that of 7 years for men in the general population of the same age. For female patients of mean age 80 years, the life expectancy was 4.5 years (95% CI 3.6–5.7), compared with 8.5 years for the general population of women of the same age.
The presence of chronic heart failure in older patients results in an approximately 50% reduction in life expectancy.
Source: Am Heart J 2006;151:1322.
Labor of Love: Free Online Nursing Journal Celebrates 10 Years
Nursing’s first, exclusively online, free, peer-reviewed journal is celebrating 10 years. OJIN: The Online Journal of Issues in Nursing, which is supported by the Kent State University College of Nursing and published 3 times yearly in partnership with the American Nurses Association, fills an important niche for nursing and health care professionals. It remains free of charge to users. “Through the hard work and support of countless individuals, we’ve been able to create a place where health care professionals from around the world can dialogue about current issues affecting our professional lives,” says Editor-in-Chief and Kent State Professor of Nursing Dr. Harriet Coeling.
Each year, 3 topics are posted that focus on a current nursing issue. In the years since its 1996 inception, OJIN articles have covered diverse topics including aging, complementary therapies, continuing competence, diversity, domestic violence, entry into practice, genetics, the Health Insurance Portability and Accountability Act, nurse safety, patient safety, and infectious disease.
More than 100,000 readers access OJIN each month. The journal’s editorial staff comprises volunteers from the Kent State College of Nursing faculty. ANA provides technical expertise, staffing, and resources.
Interested businesses, organizations and individuals can contact the journal staff at ojin@kent.edu for sponsorship information. To access the journal, go to www.nursingworld.org/ojin/.
PII: S0197-4572(06)00227-8
doi:10.1016/j.gerinurse.2006.08.002
